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General NPI Number Information
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NPI Number | 1790460350
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Entity Type | Organization
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Legal Business Name | CAMP SOBE WELL OH LLC
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 4990 E GALBRAITH RD
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City | CINCINNATI
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State | OH
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Zip | 45236-6711
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Country | US
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Telephone | 954-294-7638
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Fax |
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Provider Business Mailing Address
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Address Line | 1645 PALM BEACH LAKES BLVD
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-2204
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Country | US
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Telephone | 954-294-7638
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. PATRECE A FRISBEE
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Credential | DC
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Telephone | 786-303-6862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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